annie yu, i'm sorry. annie yu. >> it's ok. so the poem i'm going to read is book of lives. my name is a book of lives. i press leaves inside, scraps of the city, one crumbled bus ticket, a number -- numb washed with rain, a torn photograph of two little girls. my name settle map of the world. a body of continents and stars. on an airplane i look at the map. flights intersect. travel miles and seas, hours and clouds, a window bird trills by my bed. power lines crisscross streets like threads in the sky. a book of lives is a month of saturdays, a sea-- seahorse from per ru, perfume at my neck. look inside a red suitcase.

you'll find letters to no one, objects found and lost, a plastic white fan, contradictory j. -- jade green, city grids, the last bite of an ice cream cone. these are all my names. i savor these words on the tip of my tongue. a book of lives lived in my right hand. i caught your pen in the other. all the rivers flower into the sea. thank you. [cheers and applause] >> next up is -- next up is marcela ortiz. >> ok. this is the first time i'm reading in front of people. ok. all right. this is a poem to my mom. you're nothing but a group of coffee klatching women.

19 years and the only image that i can think of what i hearl my mother's voice is rosie the riveter with her hand balled up in a fist and her hand underneath her face. coffee klatching women? a bunch of old grandmothers who sit in sewing sirgles and talk about the best blueberry circles. we banned my mother from the kitchenen -- because of an incident where she had burnt water the the only person who cooked was my father. please keep your peace, mom. yes, my mother say woman but coffee klatching? the term was worse than nails on the chalk board. oh, yes, a coffee klatching woman who has raised three

children and never taking shying from anyone. you sure do act like a coffee klatching women with your boots and jeans on, arriving to run a crew of obnoxious men's, because 50% of the men's brains skiptd -- consist of their oh so glorified junk which doesn't even work right. most of the time. coffee klatching women? sitting around talking nonsense? the same nonsense that finally changed the 19th amendment. yes we can vote. i can see abigail adams sitting and clutching her scorching hot cup of joe, john adams saying sit down and drink your damn coffee, woman.

she really was the brains of the outfit. my mother is overworked, tired, but her still solid body stood hard as a rock. i'm not going to cry, as a tear falls down from her face. don't cry, mom, don't cry. [cheers and applause] >> that was her first time ever. yay! and up next we have indiana telepenova. >> a recipe for water. start with the color magenta, a burning asphalt, of beach ball sighing out its life, a garden grown on accident after

accident, add a father painting shelves on the cove, a pinch of guilt, statues of isabella butter flisse -- butterflies, and extinct alpha betts, a teaspoon of autumn leaves, a shepard playing with the winds, some animal begging for snow. mix vigorously like the mountain mixes up its slopes. preheat the bed of a star to -- 240 light-years away. thank you. and next is -- [cheers and applause] >> next is robin black.

>> hi, robin! >> oh, ok. i had to know. this is called "eviction notice." the police turned us away. 11 years old eating baby food. days warm like the occasional free matsoff from next door. no plates the cups were yoplaits. i stepped on a nail taking my sister through the yard the drinking from beer bottles that tasted like warm quarters the i caught fleas from cookie puss sleeping on my stomk keeping us both warms. at that age i lost the comfort from lies. stranded on a crescent move, floating in a sea of ash littered with diamonds the i swallowed past lives to spit

these alternate futures. >> one more big round of applause for our very talented apprentice program. fantastic.

i've been clean four years! fifty-six ys! i've been in long-term recovery for 23 years. i've been in recovery for six months and love it! i've been in recovery for over 15 years! every september, people gather all across the country to celebrate recovery from addiction. i am so grateful for 19 years of recovery. it's changed my life, changed my children's lives. for information or for events near you, visit recoverymonth.gov get involved and join the voices for recovery. [music]

hello, i'm ivette torres and welcome to another edition of "the road to recovery." today we will be talking about diversity issues within the addiction and recovery field. joining us in our panel today are dr. h. westley clark, director, center for substance abuse treatment, substance abuse and mental health services administration, u.s. department of health and human services, rockville, maryland. marco e. jacome, chief executive officer, healthcare alternative systems incorporated, chicago, illinois.

john de miranda, president and ceo, stepping stone, san diego, california. william lossiah-bratt, board of directors, southeastern regional representative, faces and voices of recovery, cherokee, north carolina. dr. clark, why should we be concerned about ethnic and racial differences within the addiction and recovery field, as well as other differences? well, one of the things that we want to make sure is that people who have substance use problems are able to recover and that materials that we use can assist them in that process. and so, you know, there are differences associated with cultural values and beliefs, starting from how one physiologically responds to a particular substance misuse to how certain substances are used in a cultural context.

so if we're going to facilitate recovery, we need to understand the language, the beliefs, the social context associated with those substances. and that will help us facilitate that person's recovery by showing that we understand the life experiences that they have associated with their use of substances. and i gather that includes prevalence as well. well, yes, but from a clinical point of view, i mean people look at the epidemiologic data and there are differences in prevalence. but the key issue for the individual who has the problem, whether you have a low prevalence phenomenon- for instance, asians tend to have a lower prevalence of alcohol misuse than other ethnic groups- imagine you are that person who has the alcohol problem. now from a cultural point of view, it may mean that you may have a harder time getting support from your community, but the fact is you need to be able to put together a recovery plan and need to be able to operate with that recovery plan in mind.

and i think then people who are helping to facilitate your recovery need to be aware that you may have fewer assets in your community because the problem tends to be rare, but you still have the problem. and, marco, that includes also socioeconomic differences, right? i am sure that in your practice, you see a difference between one sector and another. absolutely. you know, even within cultures, we have subcultures and socioeconomic status, education, plays a major role in terms of recovery. we target mostly in our center blue collar workers and the approach is totally different than middle class and upper class hispanic. william, within the native, american indian community, i am sure there are going to be so many differences, differences among the tribes and even within the tribe. can you address some of those? most definitely.

the interesting thing with native american tribes is previously people would automatically assume that one tribe was the same as the next. my particular tribe, the cherokee, are completely different than our cousins out in oklahoma, the cherokee nation of oklahoma. within our reservation in north carolina, we have seven individual communities and each of those communities is completely different. we're a collective people, but we're all individualized in our communities. and how do they differ in terms of service delivery, for example, when you have to address their addiction issues? it comes down to developing that level of trust. some of our communities, it seems to be the communities that are closest to the center of the reservation are more apt to seek services as opposed to some of our more isolated communities, especially up in the mountain regions. very good. john, in your line of work you deal mostly with

lgbt communities and i know you have experience with the disability sector as well. can you talk to us about particular idiosyncrasies within these that need to be addressed as opposed to the rest of the population? yes, certainly. the lesbian, gay, bisexual, transgender community has a variety of idiosyncrasies, but i'd like to o go back to your first point, too, and say that one reason to have culturally specific treatment is because sometimes people cannot access treatment. stepping stone came into existence 35 years ago because gay men and lesbian women in san diego could not get into those recovery resources that were available then. or if they could, their experience was negative. so a number of people came together and said, well, let's start something for our community, and that was really the beginning of stepping stone, and i think that is true for a lot of these kind of culturally specific treatment programs.

idiosyncrasies, sure. life in an alcohol and drug treatment program for the lgbt community is very different in many ways because the issues are very different. for example, when we built the facility 10 years ago, we had this very nice staircase that was going up to the second level. and our then ceo said to the architect, "i want that staircase to look like a woman's high heel shoe." it does, and that's one thing that is what makes stepping stone different from other treatment programs. so they adapted to their aesthetic. exactly, exactly. and the jokes are different and the interactions are often very different. and i suspect that that makes a difference. i mean, when somebody walks in and, you know- it's an icebreaker, almost. yes. the dynamics are very different. we have also transgender clients in our treatment program which again change the dynamics again kind of like what william was saying. that the transgender community is very different from the gay community and the lesbian community,

so we have to make accommodations for that, too. marco? it has been proven that when you have treatment, culture specific enhances the ability to recover the individual. i will give you an example in terms of the hispanic population. we have a residential program where meals are prepared by home, you know. it's not a cafeteria meals that we prepare, but we have cooks who are sensitive to the culture. and that really brings home to a particular person who is in recovery and engagements. so, so important for recovery to be culture sensitive and ingredients that enhance recovery and the support in our environment of treatment. and i'm glad you mentioned the whole issue of culture sensitive. i want to go back to dr. clark. what does culture sensitive mean? if someone is listening to this show, what does it mean to be culture sensitive?

we've heard from our speakers addressing the cultural differences and the culture sensitivity means that the clinician particular or the recovery dynamic recognizes that a person's life experiences have to be taken into consideration, so the idioms, the beliefs, the perceptions, the mores, all of those things. so you may make an assumption based on your own culture that has nothing to do with this other person's life experiences. as was pointed out - food, for instance, is often a cultural dynamic and you can assume that here's a dish that everyone relates to and it actually may be so alien to the person that you're trying to help that they don't understand what you're trying to accomplish. so cultural competence is what we're trying to foster, recognizing the diversity of cultural experiences. and in the substance abuse arena, what we are trying to facilitate is that recovery and in the mental health arena,

we're trying to facilitate that recovery. so we need to take into consideration all of those things - mores, beliefs, icons, that affect that person's perception. and the clinician or the facilitator, if you're talking about recovery, needs to recognize that. we do have an advantage, though, when we talk about cultural competence. we know we're trying to facilitate the recovery from alcohol and drugs. that's the common motif that we can relate to. so whether it's an aesthetic in terms of a woman's shoe, in a treatment program, you're still trying to facilitate the recovery, whether it's a gay, lesbian, bisexual individual, an american indian, alaska native, someone from the hispanic community, a white from appalachia. you're still trying to facilitate recovery. so that is the one thing that we have in terms of cultural competence and we have to radiate out from that by bringing in all the other idioms and icons and beliefs

associated with substance use, but we're trying to achieve that. so that gives us a good position to start from. very good. when we come back, i want to get more into really the specifics among groups of what the, basically, the approach should be for each one of these groups within the context of providing services. we'll be right back. well, i think treatment programs that recognize that language and cultural icons and support and cultural imagery play a critical role in how a person relates both psychologically and socially could position themselves to do a better job

at reaching the person who is affected. so one size does not fit all, but the strategy is one of welcoming and incentivizing through environmental and social and psychological support. so whether you're in a hispanic social organization or an african american social organization or a gay, lesbian, bisexual, transgender social organization, that is not the issue. the issue is, are you having a problem with alcohol and drugs and if so, does your social context acknowledge that there are those problems and does it embrace recovery as a construct. because that's the other thing we want to push is social support for being in recovery. treat me- treat me with understanding. treat me- treat me with courtesy. drug and alcohol addiction is an equal opportunity disease. individuals in recovery come from all walks of life and deserve to be treated with respect and

admiration for winning one of the hardest battles there is. treat me without judgment. treat me- with humanity. alcohol and drug addiction deserves proper treatment. for drug and alcohol information and treatment referral, call 1-800-662-help. i had no idea it was going to be so hard. i didn't know what to expect. you hear the stories, but i never took any of it seriously until i found myself here. and then i realized i was going to have to work hard for my recovery. if you or someone you know has a drug or alcohol problem, you are not alone. call 1-800-662-help recovery was the hardest job i ever had. and the most important. brought to you by the u.s. department of health and human services.

i am a person in long-term recovery and in my case that means i've been without alcohol or drugs for 35 years. during that time, i have noticed that there is a new recovery movement starting in this country and probably about 10 years ago and i have gotten very involved in an organization called faces and voices of recovery, which is a leadership group within that movement. it's been very exciting to see that more and more people are coming out of the closet, that reducing stigma, reducing discrimination and kind of normalizing recovery is what is happening in this country. it's very exciting to see that having a longer term perspective that goes back 35 years when everybody seemed to be in the closet back then. dr. clark, i know that we've talked a little bit about certain aspects of diversity and one of them is gender. i know that samhsa has a program that is targeted to women and children and pregnant postpartum. do you want to talk a little bit about that? you are correct when you mention that gender is an important

part of cultural dynamics and cultural competence. one of the things that we recognized a long time ago was that we needed to make sure we had some gender-specific programming. and that also included programming that allows women to bring their children into the treatment environment and to allow women who are pregnant to deliver in the treatment environment. it works to their benefit and it also reassures the larger community that that woman who has an alcohol or drug problem will deliver a child who is free of alcohol and drugs. so that reassures the community and also gives that woman a greater sense of personal dignity and responsibility as a parent. because we're dealing with powerfully reinforcing psychoactive substances, that many times when

people have the responsibility for children, but who have addiction problems, they are unable to maintain the necessary balance. by having support, they can achieve that balance. so we fund a number of programs that offer a continuum of support, the acute support during the time the woman is pregnant to when she delivers. also allowing, in some programs, up to five kids to be brought into the therapeutic environment so that the mom can continue with her treatment. and one of the other things that we're doing is also bringing in fathers into the calculus. sometimes the father or the other parent has a substance use problem, sometimes they don't. but we're able to make sure that the mom and her child are safe and then the co-parent who is interested in

being in the life of the mother and child is able to do so, so that we give the child the best support possible and at the same time helping the mom in her recovery. so these become very important strategies to help facilitate, because gender is important, parenting is important. and the social expectations, many of these women feel that they are less than because they have an alcohol or drug problem and sometimes they are judged harshly by the communities because they are- well, why didn't you- if you're pregnant, you just don't stop using? well, these are powerfully reinforcing psychoactive drugs and psychoactive substances, so you need some- an environment where you can facilitate stopping use of these substances. you can't just automatically stop for many women. so these programs offer that. one dynamic of that program is that i thought was extremely helpful was that you teach the mothers to be better mothers.

you teach them parenting skills while they are, as you mentioned, working with the children to adapt better to a family situation. even though they may be single mothers, but it helps them to adapt. and marco, in terms of your program with the latino community, i suspect that you have similar approaches. absolutely. gender specific is so crucial because- let's just talk about a woman's different issues than the male population. in our center, you know, women come for an outpatient and the issues that they are bringing to the table is totally different than the male population. so i encourage programs that even though limitation of resources might not be there to have gender specifics because women's issues of being a mother, being a wife, being a good parent has a different connotation than a male population.

so also the issue of, again, feeling as a second citizen, they have never been given the respect at home to be a good mother, to address issues that they might have, feelings. especially the hispanic population, because the male issue of machismo brings a lot of issues with a woman in terms of not being felt respected and being wanted, and especially with addictions. and i suspect that if programs were looking for not only what you have mentioned in terms of adapting programs to latino communities, but also to really- we haven't really talked about checking, and i don't want to create a stereotype while talking about diversity- but really checking, having talked about the machismo, checking for other factors such as the domestic scene, and making sure- dealing